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The changes in the barrier properties due to the damage imposed on the SiOx deposited nylon 6 films accompanying various deformations such as bending and elongation were examined by evaluating the corrosion rate of the copper plates by H2S kept in the pouches made of the damaged films. After application of elongational deformation of as high as 2% or less, only slight corrosion of the copper plates, almost similar to those of the copper plates kept in the pouches made of undeformed films, was observed. After application of elongational deformations of 3% or more, the corrosion of the copper plates was more distinct and proceeded significantly with time, Bending deformation given to the SiOx deposited nylon films also deteriorated the barrier property to H2S when the radius of curvature at the bent part was small. Comparison of the corrosion rates of the copper plates kept in the pouches made of films deformed in various ways and undeformed commercial films shows a clear relationship between the H2 permeation rate of the films and the corrosion rate of the copper plates by H2S.

胸骨全切開下に体外循環を用いず常温,心拍動下に回旋枝を含む多枝冠動脈バイパス術を行うOff pumpCABGを10症例経験した.末梢側吻合時に血圧,心係数はスタビライザ装着により装着前に比して有意に低下した.心拍数の上昇,心収縮力の増加は血管吻合を困難にするためβ刺激作用のあるカテコラミンの投与は少量にとどめ,純粋なα刺激薬により末梢血管抵抗を上昇させて血圧を維持した.心拍数はプロポフォール,ジルチアゼムを用い80beats・min-1程度に維持した.適正な麻酔深度を保ちつつ早期抜管を目指し,循環動態の安定と良好な術野の提供を両立させる麻酔管理が要求された.

It is known that blood concentration of rocuronium increases after administration of sugammadex, but this is not clear in the case of vecuronium. We report a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. A 19-month-old girl weighing 7.8 kg had a history of aortic valvuloplasty at 4 months of age due to truncus arteriosus. She presented again to our hospital due to aortic regurgitation. She underwent aortic valvuloplasty and then aortic valve replacement. The postoperative course was complicated with severe heart failure and acute kidney injury requiring peritoneal dialysis. For that reason she required long-term sedation including administration of a large amount of muscle relaxant due to severe low cardiac output syndrome after aortic valvuloplasty. A total of 615 mg (79 mg x kg(-1)) of vecuronium was administered over a period of 24 days. On weaning from mechanical ventilation, 125 mg (16 mg x kg(-1)) of sugammadex was given. Vecuronium concentration measured by high-performance liquid chromatography (HPLC) was 5.03 ng x ml(-1) before sugammadex administration and increase to 13.98 ng x ml(-1) after that. However, blood concentration of metabolic products of vecuronium did not exceed the lower limits of measurement in each sample. She was successfully weaned from mechanical ventilation without recurarizarion. Serum concentration of vecuronium increased after administration of sugammadex because extravascular vecuronium was redistributed to intravascular space according to the concentration gradient induced by binding and clathration of vecuronium. The measured values of vecuronium after sugammadex administration on HPLC represented the total amount of free vecuronium and vecuronium combined with sugammadex. Recurarization might occur after sugammadex reversal in patients after long-term administration of vecuronium, especially if relatively smaller doses of sugammadex were given. We experienced a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. There is a risk of recurarization after sugammadex reversal in patients after long-term administration of vecuronium.

Silicon monoxide (SiO) amorphous layer was deposited on the biaxially oriented nylon 6 films in a vacuum evaporator. This deposited layer tightly attaches to the nylon film. SiO deposited nylon 6 films thus obtained are transparent and show a high barrier to the water vapor and oxgen. Wettability of the SiO surface of the film to the water, ink, and the adhesives are satisfactory for the gravure printing and lamination with polyolefin films. It was found that the gloss of nylon film, which reflects the surface roughness of the film, affects the uniformity of SiO deposited layer on the nylon film and barrier property of the deposited films. Permeabilities of the water vapor and oxygen through the SiO deposited nylon films were fairly high just after the deposition, especially when the deposited layer was thin, and then decreased to lower equilibrium values. These equilibrium values are surprisingly low comparing with other high barrier films such as nylon and polypropylene films coated with poly (vinylidene chloride). Further the SiO vacuum deposition was continuously carried out on the running nylon film. We found that the thickness of the silicon oxide layer on the nylon film and the water permeability are strongly related to the running velocity of the nylon film and the applied electric current to the heater.

We report a case of severe dilated cardiomyopathy with an automatic implantable cardioverter-defibrillator (ICD) undergoing total gastrectomy. During the operation, the defibrillation function of the ICD was suspended and its pacing function was used solely in VOO mode. Electrodes of an external defibrillator were attached on the chest wall, and a pulmonary arterial (PA) catheter with a ventricle pacing port was inserted into the pulmonary artery. Proper perioperative management, including measures that the patient underwent the surgery uneventfully and could attain a rapid and successful discharge from the intensive care unit.

There are limited data about the correlations between amount of anesthetics and variations in vital signs during pediatric cardiac catheterization.Data in 80 children with congenital heart disease undergoing cardiac catheterization with/without interventional cardiology in 2004 were examined in this retrospective cohort study. Data on blood pressure, heart rate, oxygen saturation, partial tension in end tidal carbon dioxide (PETCO2), and total amount of anesthetics given during general anesthesia were obtained from anesthetic charts. The correlations between amount of anesthetics and those vital signs were analyzed.Median age of the patients was 14 months and median body weight was 8.8 kg. Median rates of variation in heart rate, blood pressure, oxygen saturation and PET(CO2) were 22.8%, 29.3%, 5.9% and 10.8%, respectively. Although there were no statistical correlations between those vital signs and amounts of anesthetics such as fentanyl, vecuronium and sevoflurane, rates of variation in heart rate was smaller in patients for whom the amount of fentanyl given was more than 4 microg x kg(-1) x hr(-1).There were no associations between amount of anesthetics and variations in vital signs in pediatric cardiac catheterization.

An excimer laser sheath has recently been used for extraction of pacing and ICD leads. By using this technique, leads are removed more easily and it has to take a shorter time to extract leads. Although lead extraction with this method can cause fatal complications such as large vessel injury, little has been reported regarding anesthetic management during the lead extraction. We experienced two cases of pacing lead extraction using an excimer laser sheath under general anesthesia. The procedures were mainly performed by cardiologists in the operating theater. A wide area was prepared with sterile drapes as for cardiac surgery with cardiovascular surgeons standing by. Vascular access catheters were placed in the right femoral artery as well as vein, and in the right internal jugular vein so that immediate PCPS introduction could be performed in case of sudden hemodynamic collapse by massive bleeding. In the first case, lead extraction was completed without any complication, but in the second case sternotomy was performed by cardiac surgeons for safe separation of leads from vessels. There were also no bleeding episodes in the second case. Preparation for bleeding and cooperation among cardiologists, cardiovascular surgeons, medical engineers and anesthesiologists are necessary from the safety point of view of this procedure under general anesthesia.

脊椎麻酔時の鎮静に用いるミダゾラム静注の至適投与量について,再検討を行なった。30～70歳の脊椎麻酔症例115例を対象とした。麻酔はL3-4あるいはL4-5より,ネオペルカミンS®あるいは0.5%テトラカインを用いて行ない,執刀後,ミダゾラム0.025, 0.05, 0.075, 0.1, 0.125mg/kgをおのおのbolusで静注した。呼名反応,睫毛反射,舌根沈下,昇圧剤使用,体動,嘔吐等の有無,血圧,心拍数,呼吸数に関して各投与量間で比較検討した。その結果,呼吸,循環に与える影響は,0.025mg/kg, 0.05mg/kgが小さく,鎮静,催眠作用は投与量が多いほど強力で,0.075mg/kg以上では舌根沈下症例数が増加するため,0.05mg/kgが至適投与量と考えられた。

The benefit of tranexamic acid (TXA) in pediatric cardiac surgery on postoperative bleeding has varied among studies. It is also unclear whether the effects of TXA differ between cyanotic patients and acyanotic patients. The aim of this study was to test the benefit of TXA in pediatric cardiac surgery in a well-balanced study population of cyanotic and acyanotic patients. A total of 160 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (81 cyanotic, 79 acyanotic) were included in this single-blinded, randomized trial at a tertiary care university-affiliated teaching hospital. Eighty-one children (41 cyanotic, 40 acyanotic) were randomly assigned to a TXA group, in which they received 50 mg/kg of TXA as a bolus followed by 15 mg/kg/h infusion and another 50 mg/kg into the bypass circuit. The other 79 patients were randomly assigned to a placebo group. The primary end point was the amount of 24-h blood loss. The amount of 24-h blood loss was significantly less in the TXA group than in the placebo group [mean (95% confidence interval): 18.6 (15.8–21.4) vs. 23.5 (19.4–27.5) ml/kg, respectively; mean difference −4.9 (−9.7 to −0.01) ml/kg; p = 0.049]. This effect of TXA was already significant at 6 h [9.5 (7.5–11.5) vs. 13.2 (10.6–15.9) ml/kg, respectively; mean difference −3.47 (−7.0 to −0.4) ml/kg; p = 0.027]. However, there was no significant difference in the amount of blood transfusion between the groups. There was also no statistical difference in the effect of TXA in each cyanotic and acyanotic subgroup. TXA can reduce blood loss in pediatric cardiac surgery but not the transfusion requirement ( http://ClinicalTrials.gov number NCT00994994).

本報では, ナイロン6繊維およびフィルムの改質を目的として, オゾン酸化によるビニルモノマーのグラフト重合について検討した. ビニルモノマーとしてはアクリルアミド, メタクリル酸メチル, および酢酸ビニルを選んだ. 実験の結果, まず, ナイロン6繊維がオゾン酸化にとってわずかではあるが分解することが明らかとなった. アクリルアミドのグラフト重合に際しては, オゾン酸化法のみでなく, あらかじめ空気中および真空中γ線照射した後でさらにオゾン酸化法を適用することにより, グラフト率の増加が認め図れた. メタクリル酸メチルのグラフト重合の場合は, オゾン酸化の処理時間を長くしてもグラフト率の増加があまり見図れなかった. 一方, 酢酸ビニルのグラフト重合の場合には, ナイロン6との相溶性が高いためグラフト率はオゾン酸化の処理時間に応じて増加していく傾向が認められた.

A male child, aged 1 year, with pulmonary atresia, ventricular septal defect and major aorto-pulmonary collateral arteries (PA, VSD, MAPCA) underwent corrective surgery including MAPCA ligation uneventfully. A few hours after admission to the ICU, severe heart failure, refractory to aggressive cardiac support including epinephrine infusion, became worse. Emergent cardiac catheterization on postoperative day 5 demonstrated the residual MAPCA and its occlusion by coil embolization dramatically resolved heart failure, indicating that the primary cause of this hemodynamic instability was likely excessive left-to-right shunt due to MAPCA. Residual LR shunt should be kept in mind to be a rare but significant cause of postoperative serious heart failure.

Hypoplastic left heart syndrome (HLHS) with intact atrial septum (IAS) is an extreme type of single ventricle physiology among congenital heart diseases, in which a baby cannot supply oxygenated blood into systemic circulation without alternative pathway. We report the case of the neonate undergoing open balloon atrial septostomy (BAS) and bilateral pulmonary artery banding (PAB) soon after scheduled caesarean sections (C/S). A 35-year-old female was pregnant and fetal echocardiography at 32 weeks revealed one of the twins as HLHS/IAS. Severe hypoxia soon after birth was suspected. Thus, scheduled C/S followed by open BAS was planned. At 36 weeks of gestation, the mother was anesthetized with spinal bupivacaine and the female baby with HLHS/IAS was delivered. After diagnosed definitely by pediatric cardiologists, her trachea was intubated by anesthegiologists and umbilical catheters were placed by neonatologists. Then the baby was transferred to neighboring operating theater for BAS 68 minutes after the birth, while her Sp(O2) was maintained around 75-85% through serial procedures. Open BAS and PAB were performed under general anesthesia without any hemodynamic instability or severe hypoxia. Cooperation among anesthegiologists, neonatologists, pediatric cardiologists, and cardiac surgeons is mandatory in order to successfully complete such a rushed procedure.

Amiodarone is widely used in Europe and the United States for refractory ventricular fibrillation (VF) in various situations, such as VF after myocardial infarction or out-of-hospital cardiac arrest. We report a case of successful treatment with amiodarone of refractory VF immediately after releasing aortic cross-clamp in cardiac surgery. A 66-year-old man suffering from severe aortic stenosis underwent aortic valve replacement (AVR). General anesthesia was induced with propofol and remifentanil, and subsequently AVR was performed under cardiopulmonary bypass. Just after releasing aortic cross-clamp, VF occurred, and it continued despite multiple trials of cardioversion with direct current (DC) shocks of 20 J or 30 J. Furthermore, some DC shocks of 30 J or 50 J after administering lidocaine 60 mg and 0.5 mol x l(-1) magnesium sulfate 20 ml were also ineffective. Then, nifekalant 20 mg was administered and DC shocks of 50 J were repeated intermittently, but VF still persisted. Eventually, VF disappeared after a final DC shock of 50 J with intravenous amiodarone 125 mg. Overall duration of VF was 60 minutes. The patient's trachea was extubated three days after the surgery without any complications. Intravenous amiodarone may be one of the most useful remedies for some types of arrhythmias including persistent VE.

真空中γ線前照射法によるナイロン6繊維への各種ビニルモノマーグラフト重合において, 添加剤効果が幹ナイロンの膨潤効果と枝ポリマーの沈殿効果の両方に起因するものであるかどうかを検討するために, スチレンモノマーのグラフト重合に対する添加剤効果について詳しく調べた. その結果, メタノール, エタノール, 酢酸, 及びプロピオン酸などのように, ナイロン6繊維に対してある程度の膨潤性を示し, ポリスチレンに対して沈殿効果を有する添加剤が特に有効であることを明らかにした. また, 枝ポリスチレンの分子量もこれらの系では大きかった. 一方, スチレン以外のビニルモノマーでは, メタクリル酸メチルが大きなメタノール添加効果を示し, アクリロニトリルやアクリルアミドなどのように, モノマーがそれぞれのホモポリマーを溶解しない系ではメタノール添加効果が殆ど認められなかった. このようにして添加剤は同時γ線照射法でも真空中γ線照射法でも全く同様な挙動を示すことが明らかとなった.

Molecular characterization of polystyrene grafted onto nylon 6 fiber by a γ-ray pre-irradiation technique in air was performed. The molecular weight and molecular weight distribution were determined by measuring limiting viscosity number |η| in m-cresol of fractions of the grafted polystyrene obtained from the nylon 6-styrene graft polymer as well as of the homopolystyrene produced in the nylon 6-styrene system. The molecular weight distribution of the grafted polystyrene was rather broad compared with that of the homopolystyrene produced by the γ-ray pre-iradiation method under the same experimental conditions. Partial occurrence of H-type grafting (the propagation of a grafted chain is terminated by the reaction with another propagating grafted chain.) of polystyrene onto nylon 6 fiber was suggested in the latter period of the nylon 6-styrene system, while T-type grafting (the propagation of a grafted chain is terminated by the reaction with propagation chain of homopolymer) predominated in the nylon 6-styrene/toluene system.

Vinyl monomers, such as styrene, methyl methacrylate, methyl acrylate, vinyl acetate, acrylonitrile, and acrylamide, were grafted onto nylon 6 fibers by a simultaneous γ-ray irradiation technique. The effects of various additives on the apparent percent graft as well as on the molecular weight and mole number of grafted vinyl polymer branches were investigated. The molecular weight of the grafted vinyl polymer branch was determined by the limiting viscosity number of the branch polymer obtained by selective hydrolysis of the backbone nylon 6. The apparent percent graft of the grafted polystyrene increased by adding methanol, ethanol, acetic acid, or propionic acid to styrene monomer. The maximum amount of the apparent graft was obtained at the 1:1 mixture of styrene and methanol. The additive which behaved as a good swelling agent to nylon 6 and, at the same time, as a precipitant to polystyrene gave higher apparent percent graft. The apparent percent graft of vinyl monomers except vinyl acetate was increased by adding methanol or ethanol to the monomers.

Background: Tricuspid regurgitation (TR) is an important finding in hypoplastic left heart syndrome (HLHS). The aim of the present study was to investigate changes in the degree of TR after the preoperative management of HLHS with mechanical ventilation, and whether the improvement of TR under preoperative management would affect the short-term prognosis of Norwood operation. Methods: Clinical and echocardiographic data of 55 patients with HLHS who underwent preoperative echocardiography and management at Department of Pediatrics, Okayama University Graduate School of Medicine and Dentistry, were retrospectively reviewed. Preoperative management with mechanical ventilation was performed in 31 of these patients. Based on echocardiography the 55 patients were divided into a trivial–mild TR group (group A) and a moderate–severe TR group (group B). Results: After preoperative management, TR improved in six of the 31 patients and was unchanged in 25; in five of the nine group B patients, TR before management improved to the level of group A after management. In-hospital deaths after surgery included 17 of the 48 patients in group A and five of the six in group B, but there was only one death in the five patients for whom TR improved from group B to group A level. Conclusion: Preoperative management of HLHS resulted in an improvement in the degree of TR. The short-term prognosis was better for the patients in group A than those in group B, and so preoperative management is useful for HLHS patients, especially those with moderate or severe TR at admission, with the exception of severe dysplasia of tricuspid valve.

Styrene was grafted onto nylon 6 fibers by a pre-irradiation technique in air. The effects of experimental conditions, such as the pre-irradiation dose, the irradiation intensity and the polymerization temperature, on the apparent percent graft as well as on the molecular weight and mole number of grafted polystyrene were investigated. The molecular weight of the grafted polystyrene was determined by the intrinsic viscosity measurement after the hydrolysis of the backbone in concentrated hydrochloric acid. An optimum irradiation dose was observed to attain the highest apparent percent graft and the highest molecular weight of grafted polystyrene. The molecular weight of grafted polystyrene decreased with the increase in the number of grafted polystyrene and the rise in the polymerization temperature, when compared at a fixed irradiation dose.

Treatment of rats with monocrotaline (MCT), a pyrrolizidine alkaloid plant toxin, is known to cause pulmonary hypertension (PH), and it has been used as a useful experimental model of PH. Recent findings suggested that pulmonary inflammation may play a significant role in the pathogenesis of MCT-induced PH. We also demonstrated that, following MCT administration to rats, there was a significant and sustained increase in the pulmonary expression of heme oxygenase-1 (HO-1), which is known to be induced by various oxidative stresses, including inflammation and free heme, and is thought to be essential in the protection against oxidative tissue injuries. In this study, we administered hemin (ferriprotoporphyrin chloride, 30 micromol/kg b.w., subcutaneously), a potent inducer of HO-1, every 3 days to rats following subcutaneous administration of MCT (60 mg/kg) and examined its effect on MCT-induced PH and pulmonary inflammation. MCT administration caused pulmonary arterial wall thickening with marked elevation of right ventricular pressure, in association with prominent pulmonary inflammation as revealed by the increase in gene expression of tumor necrosis factor-alpha and the number of infiltrated neutrophils in the lung. In contrast, hemin treatment of MCT-administered animals, which led to a further increase in pulmonary HO-1 mRNA expression, significantly ameliorated MCT-induced PH as well as tissue inflammation. These findings suggest that hemin treatment ameliorates MCT-induced PH possibly mediated through induction of pulmonary HO-1 which leads to the attenuation of pulmonary inflammation.

We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD) in pediatric cardiac care units.A retrospective observational study was conducted in a pediatric cardiac care unit in a tertiary care university hospital. The subjects were 40 patients with AKI requiring PD between 2003 and 2005, and controls matched by type of surgery and body weight. Acid-base variables, including blood gas data and electrolytes, were assessed. The Stewart-Figge variables, including strong ion difference apparent (SIDa), strong ion difference effective (SIDe), and strong ion gap (SIG), were calculated.Blood gas analyses showed that the PD group was more acidemic, with a lower mean bicarbonate and a lower mean base excess, typical features of metabolic acidosis. The strong ion analyses revealed that the PD group had lower mean sodium and albumin concentrations. Based on the Stewart-Figge methodology, SIDa was smaller in the PD group than in the control group, but SIG was similar in the two groups. Receiver-operating characteristic curve analyses showed that serum albumin was the only prognostic factor associated with PCCU mortality, even after adjustment for PD treatment.Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value.

Background: Hydrogen peroxide (H 2 O 2 ) is a well recognized candidate for EDHF. The aim of this study was to examine H 2 O 2 -EDHF function in coronary arterial microvessels under conditions of increased oxidative stress in RV of pulmonary hypertension (PH). Methods: Monocrotaline (60 mg/kg SC) was administrated in 5 week-age male Sprague-Dawley rats to induce PH (PH; n=52). Saline was injected in control rats (n=47). After 3 weeks, RV coronary arterioles (CA; 30 –100 μm) and small arteries (CSA; 100 –200 μm) were visualized in vivo using our intravital videomicroscopy. After cyclooxigenase blockade, Acetylcholine (ACh; 2 μg/kg/min IV) induced vasodilation was evaluated under three conditions; ACh alone, N ω nitro-L-arginine methyl ester (L-NAME), L-NAME+catalase. Differences of percentage vasodilation between ACh alone and L-NAME, and between L-NAME and L-NAME+catalase were used as relative indices for the contributions of NO and H 2 O 2 -EDHF, respectively. Malondialdehyde (MDA) in plasma was measured with colormetric assay. Superoxide production in RV was determined by lucigenin-derived chemiluminescence. Results: RV systolic pressure was significantly increased in PH (75±13 vs. 31±3 mmHg; p2 O 2 -EDHF in PH was greatly increased for both CA (from 48% to 60%) and CSA (from 28% to 53%) (both p2 O 2 produciton and contribute to the robust EDHF function. Conclusion: Under conditions of increased oxidative stress in PH, H 2 O 2 -EDHF plays a crucial role against NO dysfunction in RV coronary microcirculation.

A male newborn infant born at 38 weeks of gestation and weighing 2,660 g, was diagnosed as esophageal atresia. Although there was mild cyanosis at birth, his initial ultrasonographic examination performed by neonatologist showed normal anatomy of the heart. He underwent a surgical repair of esophageal atresia under general anesthesia. Anesthesia was induced with fentanyl and pancuronium, and maintained with sevoflurane and 60% oxygen. Frequent desaturation occurred during the procedure, requiring manual hyperventilation with 100% oxygen. Since blood pressure during the operation was unstable, volume loading with albumin was attempted. Further echocardiography was performed by pediatric cardiologist after going back to NICU. This revealed total anomalous pulmonary venous connection (TAPVC). He underwent cardiac surgery for repair of TAPVC on the next day. Although TAPVC was not preoperatively diagnosed regardless of results of echocardiogram, cyanosis and unstable blood pressure should be considered as signs of potential cardiac disease. Fluid restriction, higher hemoglobin, lower inspired oxygen and slightly higher carbon dioxide rather than albumin administration and hyperventilation should have been attempted during the esophageal repair.

Tracheobronchomalacia can be latent without showing any clinical manifestations and may be incidentally found during anesthesia. In such cases, hypoxia may occur during anesthesia. We experienced obstruction of the left main bronchus caused by bronchomalacia that was incidentally found during open-heart surgery in a 4-yr-old patient. We could not reopen the airway by routine techniques, such as positive pressure, and had great difficulty in weaning the patient from cardiopulmonary bypass. The use of a Fogarty catheter allowed the relief of airway obstruction and weaning from cardiopulmonary bypass.

Monocrotaline (MCT), a pyrrolizidine alkaloid plant toxin, is known to cause pulmonary hypertension (PH) in rats. Recent findings suggest that pulmonary inflammation may play a significant role in the pathogenesis in MCT-induced PH. Heme oxygenase-1 (HO-1), the rate-limiting enzyme in heme catabolism, is known to be induced by various oxidative stresses, including inflammation and free heme, and its induction is thought essential in the protection against oxidative tissue injuries. In this study, we examined expression of HO-1 as well as non-specific delta-aminolevulinate synthase (ALAS1), the rate-limiting enzyme in heme catabolism and biosynthesis, respectively, in a rat model of PH produced by subcutaneous injection of MCT (60 mg/kg). MCT treatment caused infiltration of inflammatory cells, fibrosis of the interstitium, and pulmonary arterial wall thickening with marked elevation of right ventricular (RV) pressure, which are characteristics of MCT-induced PH. Gene expression of tumor necrosis factor-alpha (TNF-alpha) as well as DNA binding activity of nuclear factor-kappaB (NF-kappaB) increased at 1 week after MCT treatment, reached a maximum at 2 weeks, and then decreased to the pretreatment level at 3 weeks. HO-1 expression was markedly increased at 1 week, and continued to increase by 3 weeks following MCT treatment, both at transcriptional and protein levels in the mononuclear cells in the lung. ALAS1 mRNA levels in the lung also significantly increased at 2 weeks after MCT treatment. These findings suggest that pulmonary HO-1 expression was presumably induced by proinflammatory cytokine(s) in MCT-treated rats, resulting in the derepression of heme-repressible ALAS1 expression, and that HO-1 induction plays a significant role as an inflammatory factor in this condition.

A recent modification of the Norwood procedure involves the use of a right ventricle-to-pulmonary artery (RV-PA) shunt to provide pulmonary blood flow for patients with hypoplastic left heart syndrome (HLHS). We investigated the hemodynamics after first-stage palliation of HLHS with RV-PA shunt compared with classic Norwood procedure with subclavian-to-pulmonary artery (BT) shunt.The postoperative course of 12 infants who had undergone first-stage palliation for HLHS using BT shunt (group BT: n=6) and RV-PA shunt (group RV-PA: n=6) were retrospectively reviewed and we obtained the following data: blood pressure, heart rate, inotropic support, atrial pressure, lactate, base excess, PaO2, FIO2.The RV-PA shunt using a non-valved conduit provided higher diastolic blood pressure than the BT shunt, but no significant difference in heart rate, systemic blood pressure, inotropic support and atrial pressure was observed between the two groups. Although the infants in the group RV-PA required significantly more myocardial ischemic time for operative procedure than those in the group BT, the serum lactate level in the group RV-PA was significantly lower than those in the group BT.These results show that the RV-PA shunt provides a stable systemic circulation and abundant tissue oxygen supply. Excellent hemodynamics provided by RV-PA shunt is beneficial for infants undergoing stage I palliation for HLHS.

This report describes usefulness of intraoperative transesophageal echocardiograpy (TEE) based on 773 cases we experienced in 7 years. We assessed residual lesions, ventricular function and preload with TEE. We found a case with stenotic lesion in her lateral tunnel which TEE revealed after Fontan procedure. We also ensured that no micro air bubble was in the left ventricle and the left atrium before weaning from cardiopulmonary bypass. No patient suffered from convulsion during postoperative management after induction of intraoperative TEE examination though we had had some cases in the previous year. Respiratory compromise was observed in 3 cases (0.5%) and significant hemodynamic change occurred in 9 cases (1.3%). The conditions improved just after withdrawing TEE probe. Neither inadvertent tracheal extubation, nor serious complication occurred during TEE examinations. The incidence of complications during pediatric TEE is low and TEE examination is useful for pediatric patients with congenital heart disease.

IT is believed that complete heart block is unlikely to occur in patients without preexisting left bundle branch block. We describe the occurrence of complete heart block during attempted placement of a central venous catheter in a child with mucopolysaccharidosis (MPS) type VII (Sly syndrome) without preexisting left bundle branch block. Numerous reports of anesthesia in patients with MPS have described airway management and respiratory complications. However, cardiac problems during anesthesia in patients with MPS should he considered important because of the possibility of preexisting cardiomyopathy or coronary stenosis.

Thirty patients undergoing lower abdominal surgery were studied to compare liver and renal functions in total intravenous anesthesia (TIVA) using midazolam and fentanyl with those in enflurane-nitrous oxide anesthesia (GOE).Patients were randomly divided into two groups of 15. In the TIVA group, anesthesia was induced with 0.3 mg·kg(-1) midazolam and maintained with 0.68 mg·kg(-1)·h(-1) midazolam for 15 min followed by 0.125 mg·kg(-1)·h(-1) midazolam and fentanyl. In the GOE group, anesthesia was induced with 5 mg·kg(-1) thiamylal and maintained with enflurane-nitrous oxide in oxygen. Plasma levels of aspartate aminotransferase, alanine aminotransferase (ALT), lactate dehydrogenase, total bilirubin, alkaline phosphatase, γ-glutamyl transpeptidase (γ-GTP), blood urea nitrogen (BUN), and creatinine (Cr) were measured before and at 1, 7, and 30 days after surgery. There were transient increases beyond the normal range in ALT and γ-GTP in both groups. BUN and Cr were within the normal range. There were no differences between the two groups regarding these parameters and the numbers with abnormally high levels of each parameter. In conclusion, liver and renal functions following TIVA using midazolam and fentanyl were the same as those following enflurane-nitrous oxide anesthesia.

The optimal administration time for intramuscular injection of midazolam as premedication was studied. Sixty patients ranging in age from 40 to 65 were included. A combination of atropine 0.3-0.5 mg and midazolam 0.08 mg·kg(-1) was given to four groups of 15 subjects each in intramuscular injections 45, 30, 15 min, and immediately before entering the operating room. Blood pressure, heart rate, respiratory rate, depression of the root of the tongue, eyelash reflex, degree of sedation, and amnestic effect at the time of arriving the operating room were compared among the groups. There was no difference among the groups in blood pressure, heart rate, and respiratory rate. The depression of the root of the tongue, disappearance of verbal response, and eyelash reflex were found in the 30- and 45-min groups. The degree of sedation and amnestic effect were good except for the group who received midazolam immediately before entering the operating room. From the above results, intramuscular injection of midazolam 0.08 mg·kg(-1) with atropine 0.3-0.5 mg is considered best when administered 15 min before entering the operating room.

To investigate the defensive roles and production of interferon and antibodies, C3H/He mice were subjected to various immunosuppressive treatments and infected with influenza virus. In infected normal control mice the pattern of pulmonary viral growth can be divided into three phases. The first phase is characterized by an exponential increase of virus titer, the second by a rapid decrease, and the third by a moderate decrease. At the time of transition from the first phase to the second in pulmonary virus growth, interferon could be detected in the tracheobronchial washings of infected mice, but neutralizing antibodies could not. In infected B cell-deprived mice and infected anti-µ-treated mice, the transition from the first phase to the second occurred without any detectable antibody production, and interferon could be induced in the early stage of infection. However, the pulmonary virus in these mice increased again exponentially until the death of the mice. In infected T cell-deprived mice which could not induce interferon, but produced IgM-neutralizing antibodies, the second phase was not observed after the first phase, but a transient plateau phase could be demonstrated, and then the pulmonary virus increased again exponentially until the death of the mice. In anti-γ-treated infected mice, pulmonary virus growth and production of interferon and neutralizing antibody were almost similar to those of infected normal control mice except for the absence of IgG neutralizing antibody production. Although anti-α-treated infected mice produced interferon and no IgA antibody, the transition from the first exponential increase of pulmonary virus to the second rapid decrease was seen, but then the virus increased exponentially again until the death of the mice. These results suggest that interferon plays an important role in the transition from the first phase to the second, and that T cells are required for interferon induction in mice infected with influenza virus. These data also suggest that IgA antibodies play an important role in the inhibition of virus propagation in the lungs after the disappearance of interferon. Moreover, infected T cell-deprived mice could produce only IgM neutralizing antibodies, but not IgG and IgA antibodies. Therefore, T cells are required for the production of IgG and IgA antibodies and eventually for defense functions in mice infected primarily with influenza virus.

When JE viruses interact with anti-JEV mouse IgG antibody (anti-JEV antibody), a resistant virus fraction remains which is not neutralized further by the antibody. This resistant virus fraction was neutralized by anti-mouse IgG rabbit IgG antibody (heterotype antibody) or anti-mouse IgG mouse IgG antibody (allotype antibody). The kinetics of this secondary neutralization was of the first order, as was that of the first neutralization by anti-JEV antibody. The rate of the secondary neutralization was proportional to the concentration of the heterotype or allotype antibody. The first neutralization could be reversed in part by dilution, and the susceptibility of the resistant virus fraction to anti-JEV antibody was increased upon dilution. On the contrary, the susceptibility of the resistant virus fraction to the heterotype or allotype antibody decreased with dilution. These findings suggested that the secondary neutralization of the resistant virus fraction was resulted in the interaction between reversibly combined anti-JEV antibody and the heterotype or allotype antibody.

The C′-PNAb induced by JEV grown in porcine kidney stable (PS) cells [JEV PS ] inactivate not only the corresponding virus, hut also Western equine encephalitis (WEE), Eastern equine encephalitis (EEE), vesicular stomatitis (VS) and Sindbis viruses grown in PS cells or primary hamster kidney (HK) cell cultures in the presence of complement. The degree of complement-potentiated neutralizing (C′-PN) ability varies for each virus. The C′-PNAb do not, inactivate these viruses grown in mouse brain, even JEV. The C′-PN activity against viruses other than JEV (PS) is completely removed by absorption with the microsomal fraction of PS or HK cells, but not of mouse brain. The antibodies in fraction IgM induced by the microsomal fraction of PS or HK cells inactivate the viruses grown in PS cells to a different degree in the presence of complement, but not viruses grown in mouse brain. The activity of C'-PNAb against JEV (PS) is reduced to 2% of the original activity by absorption with sheep red cells. After absorption, the remaining C'-PNAb are not further reduced by absorption with the microsomal fraction of PS cells, nor do they inactivate the other viruses grown on PS cells. The early rabbit hemagglutination-inhibition (HI) antibodies in fraction IgM induced by JEV (PS) could not only inhibit hemagglutination with JE, WEE, EEE, and Sindbis viruses grown on PS cells in the absence of complement, but could also facilitate HI in the presence of complement. However, they could not inhibit hemagglutination with these viruses grown in mouse brain, in the presence or absence of complement. This activity of HI could also be removed by absorption with the microsomal fraction of PS cells. These findings suggest that C'-PNAb are induced by host cell components associated with the virus, and that the early HI antibodies in fraction IgM are the same entities as C′-PNAb.

Background A change of serum lactate concentrations appeared to be useful for predicting outcomes in various acute ill settings. However, there is little information on intraoperative change of lactate level in pediatric cardiac surgery patients. Methods We conducted a retrospective observational study of 459 children who received pediatric cardiac surgery to determine the association between change of lactate level after cardiopulmonary bypass (CPB) and patient prognosis (length of ICU stay and incidence of postoperative serious adverse events (SAEs)). We defined change of lactate level after CPB (LAC⊿) as (final lactate level measurement in the operating room) – (lactate level measured at the end of CPB). To study the independent association of LAC⊿ with length of ICU stay, we used linear regression model. Results There were 1145 lactate measurements after CPB in this study cohort. After weaning from CPB, the serum lactate levels significantly increased from 2.1 mmol/L to 2.5 mmol/L (p

Antibodies to influenza virus have been shown to be present not only in serum, but also in secretions of the respiratory tract (1–4). Gamma A is the predominant immunoglobulin class in the secretions, whereas this immunoglobulin is a minor component in the serum. The γ A of the secretions differs chemically and antigenically from serum γ A. These observations suggest that antibodies associated with secretory γ A are produced locally, and are not simply the result of transudation from the serum. There is considerable indirect evidence for the synthesis of local antibodies in the respiratory tract. The problem remains to elucidate the mechanism of local antibody formation. The lymphocytosis-promoting factor (LPF) obtained from Bordetella pertussis has been shown partially to suppress the formation of circulating antibody when given intravenously in mice (5). Therefore, the possibility of demonstrating a dissociation between the levels of antibody activity in the serum and in the secretions of mice infected with influenza virus was investigated.